特立帕肽联合双膦酸盐对老年性椎体压缩骨折术后骨质疏松患者PINP和CTX-1的影响

目的探究特立帕肽联合双膦酸盐对老年性椎体压缩骨折术后骨质疏松患者I型前胶原N末端前肽（PINP）、I型胶原C末端肽（CTX-1）的影响。 方法前瞻性收集2017年9月至2018年3月在河北北方学院附属第二医院骨科就诊的老年性椎体压缩骨折术后骨质疏松患者，共44例，依据随机数字表将患者分为A组（24例），B组（20例），另取因无法耐受术后药物治疗等而未进行治疗的患者为C组（20例），给予A组：特立帕肽+双膦酸盐（唑来膦酸）+钙剂（钙尔奇D咀嚼片）治疗，给予B组维生素D+钙尔奇D咀嚼片治疗，治疗后随访12个月。记录3组随访情况及手术情况，观察并比较3组不同时间点视觉模拟疼痛评分（VAS）、Oswestry功能障碍指数（ODI）、骨密度（BMD）、（腰椎L1-4）、PINP、CTX-1、不良反应和再次骨折发生率。 结果64例患者均获得完整随访，随访率100%，随访时间12~22个月，平均（13.82±1.24）个月。64例患者平均手术时间（17.63±2.04）min，骨水泥灌注量3~7 mL，平均（3.32±0.46）mL，术后发生骨水泥渗漏12例（18.75%），其中A组5例，B组4例，C组3例。A组在治疗后3个月、6个月、9个月、12个月的VAS评分（3.06±1.12、1.82±0.74、1.52±0.54、1.41±0.49）分]和ODI指数（28.42±5.16、21.64±4.92、18.76±4.52、17.59±4.38）均小于B组VAS：（3.81±1.28、3.19±1.13、2.76±0.97、2.53±0.85）分；ODI：34.58±6.13、31.27±5.86、28.48±5.34、27.94±5.17）和C组VAS：（4.51±1.42、4.16±1.49、3.98±1.31、3.59±1.24）分；ODI：37.71±6.54、35.48±6.07、33.97±5.87、33.61±5.80）（均P<0.05），B组在治疗后3个月时，与C组比较，差异无统计学意义（P>0.05），在治疗后6个月、9个月、12个月时，均小于C组（P<0.05）。A组在治疗后3个月时，BMD、PINP和CTX-1水平（0.835±0.103）g/cm²，（134.08±27.29）ng/mL，（216.85±26.63）μg/L]高于B组（0.774±0.076）g/cm²，（93.57±19.85）ng/mL，（216.85±26.63）μg/L]和C组的（0.706±0.051）g/cm²，（49.74±10.59）ng/mL，（161.05±15.42）μg/L]，且B组各指标水平均高于C组（均P<0.05）。随访期间，A组无再次骨折患者，B组再次骨折发生率5.00%，C组发生率15.00%，但3组骨折再发率差异无统计学意义（P>0.05）。 结论特立帕肽联合双膦酸盐对老年性椎体压缩骨折术后骨质疏松患者临床疗效显著，可有效提高BMD，改善骨合成、骨吸收指标水平，显著降低疼痛及相关功能障碍程度，安全性高，值得推广。

Effects of telipatide combined with bisphosphonate on PINP and CTX-1 in elderly patients with osteoporosis after vertebral compression fracture

ObjectiveTo investigate the effect of tripartide combined with bisphosphonate on type I procollagen N-terminal propeptide (PINP) and type I collagen C-terminal peptide (CTX-1) in patients with osteoporosis after senile vertebral compression fracture. MethodsA total of 44 senile osteoporotic patients with vertebral compression fracture treated in our hospital between September 2017 and March 2018 were selected. According to the order of admission, they can be divided into group A (24 cases) and group B (20 cases). In addition, the group C (20 cases) was selected as the patients who did not receive treatment due to intolerance of postoperative drug therapy. Group A was treated with tripeptide+bisphosphonate (zoledronic acid)+ calcium (calqid chewable tablets), and group B was treated with vitamin D+calqid chewable tablets and followed up for 12 months. The follow-up and operation of the three groups were recorded. The visual analogue pain score (VAS), Oswestry dysfunction index (ODI), bone mineral density (BMD), (lumbar L1-4), serumPINP, CTX-1, adverse reactions and the incidence of re-fracture were observed and compared among thethree groups at different time points. ResultsAll 64 patients were followed up completely with a follow-up rate of 100% and a follow-up time of 12-19 months, with an average of (13.82±1.24) months, of which group A was followed up for 12-18 months, with an average of (13.57±1.17) months. Group B was followed up for 13 to 22 months, with an average of (14.23±1.29) months. Group C was followed up for 12 to 20 months, with an average of (13.71±1.20) months. The average operation time of 64 patients was (17.63±2.04) min, the bone cement perfusion volume was 3-7 mL, and the average was (3.32±0.46) mL. Twelve patients (18.75%) had bone cement leakage after operation, including 5 cases in group A, 4 cases in group B, and 3 cases in group C.At 3 months, 6 months, 9 months and 12 months after treatment, the scores of VAS in group A were (3.06±1.12), (1.82±0.74), (1.52±0.54), (1.41±0.49) respectively. ODI index were (28.42±5.16), (21.64±4.92), (18.76±4.52), (17.59±4.38) respectively. The scores of VAS in group B were (3.81±1.28), (3.19±1.13), (2.76±0.97), (2.53±0.85) respectively. ODI index was (34.58±6.13), (31.27±5.86), (28.48±5.34), (27.94±5.17) respectively. The scores of VAS in group C were (4.51±1.42), (4.16±1.49), (3.98±1.31), (3.59±1.24) respectively. ODI index was (37.71±6.54), (35.48±6.07), (33.97±5.87), (33.61±5.80) respectively. The score of VAS and ODI index in group A at 3 months, 6 months, 9 months and 12 months after treatment were significantly lower than those in group B and group C (P<0.05). At 3 months after treatment, the difference between group B and group C was not significant (P>0.05). At 6 months, 9 months and 12 months after treatment, the difference was significantly lower than that of group C (P<0.05). The levels of BMD, PINP and CTX-1 in group A were (0.835±0.103)g/cm², (134.08±27.29)ng/mL, (216.85±26.63)μg/L], higher than (0.774±0.076)g/cm², (93.57±19.85)ng/mL, (216.85±26.63)μg/L] in group B and (0.706±0.051)g/cm², (49.74±10.59)ng/mL, (161.05±15.42)μg/L] in group C, and all indexes in group B were significantly higher than those in group C (all P<0.05). During the follow-up period, There were no patients with refracture in group A, the incidence of refracture in group B was 5.00%, and the incidence of refracture in group C was 15.00%, but there was no significant difference among the three groups (P>0.05). ConclusionTelipatide combined with bisphosphonate has a significant clinical effect on senile osteoporotic patients after vertebral compression fracture surgery. It can effectively improve BMD, improve bone synthesis and bone absorption index level, significantly reduce pain and related dysfunction, and has high safety, which is worthy of promotion.